CMS Official Gives Refresher on MACRA at CDI Summit

AHIMA’s “2016 Clinical Documentation Improvement (CDI) Summit: Advancing the Documentation Journey,” which started Monday in Washington D.C., was kicked off with remarks from Dr. Wil Lo, MD, CDIP, CCA, about the emerging popularity of CDI in the United States and abroad.

Lo, a consultant with Jzanus Consulting, reminded attendees seated in the ballroom of the Washington Court Hotel that AHIMA is playing a key role in helping countries such as Oman, Qatar, Saudi Arabia, and the United Arab Emirates cultivate a CDI workforce.

“In our conversation abroad we have sensed many opportunities,” Lo said. “It’s an exciting time to be in CDI. The US is leading the charge in changing the landscape of healthcare.” Lo added that other nations are implementing similar reforms but at a slower pace. “It’s exciting to interact with all these players,” he said. “I believe this role will become even more exciting domestically and internationally.”

CMS’ Robert Anthony speaks at the CDI Summit.

CMS Previews Upcoming MACRA and MIPS Regulations
Robert Anthony, director of the quality measurement and value-based incentives group in the Center for Clinic Standards and Quality at the Centers for Medicare and Medicaid Services (CMS), delivered Monday morning’s opening keynote presentation, “The Medicare Access & CHIP Reauthorization Act (MACRA) of 2015—Path to Value.”

On April 27, 2016, CMS released a proposed rule titled “Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models.” As healthcare providers await the final rule, which Anthony said is expected “by the end of the year,” health information management (HIM) professionals can start familiarizing themselves with the MACRA-created programs they may soon be participating in.

Anthony stressed that MACRA’s MIPS program, which sunsets the “meaningful use” EHR Incentive Program, the Physician Quality Reporting System, and the Value-Based Modifier program, will be the path most physicians choose.

“As we thought about assessing providers, we thought in terms of flexibility. In working at CMS and on a number of different programs, we learned that everyone is a special snowflake,” Anthony said. “It turns out everybody has different practices and workflow—even at the specialist level. So coming up with a baseline can be difficult when you look at how people practice.”

Because of the vast array of workflows, “eligible clinicians” participating in MIPS will be able to choose from over 300 quality measures to report on in the first year of participation. Additionally, as MIPS ramps up, so does the potential for bonuses and penalties. In the first year reimbursement penalties will start at -4 percent, with bonuses starting at +4 percent. There’s also an opportunity for top performers to earn a 27 percent positive payment adjustment, Anthony noted.

Anthony stressed that MIPS, APMs and associated programs will be rolled out with a much more easy to navigate website than what CMS currently offers, earning a hearty chuckle from the audience. The website will encourage eligible clinicians to do their reporting there. He noted that he is aware that the current CMS website is unwieldy and almost impossible to wrangle.

“Reporting shouldn’t be the barrier to participation and making care better… I’m incredibly excited about the graphics and visuals [the website will provide]—things we just don’t do in government,” he said.

2 Comments

The devil is in the details. How will complete and precise ICD-10-CM coding affect physicians in MACRA and MIPS and what’s the role of CDI in assuring an individual practitioner’s success? That’s what we need to know. I don’t see that here.